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IU-led research will help dentists determine potential cavity sites, offer preventive treatment

Andrea Ferreira Zandona
Andrea Ferreira Zandona View print-quality image

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October 24, 2012

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The results of a four-year, $3.4 million National Institutes of Health-funded study led by a researcher at the Indiana University School of Dentistry will help dentists identify which at-risk sites on teeth are likely to become cavities if no preventive action is taken.

Armed with that information, dentists could treat those at-risk sites to at least delay, if not stop, them from turning into cavities. Once a cavity develops and a filling is put in, the tooth enters a repetitive restorative cycle, leading to a cascade of costly restorative treatments.

The results of the study were published in the September 2012 issue of the Journal of Dental Research. The study was led by Andrea Ferreira Zandona, DDS, Ph.D, director of the Graduate Preventive Dentistry Program, director of the Department of Preventive and Community Dentistry 's Early Caries Detection and Management Program, and associate professor in the Department of Preventive and Community Dentistry, in the IU dental school.

The study, which was conducted at IU and the University of Puerto Rico, is believed to be the first extended examination since 1966 of the natural history of dental caries, the dental term for cavities, using detailed criteria.

A total of 565 children between the ages of 5 and 13 were recruited for the study in 2007. Of these, 338 children completed all examinations. The children were examined at regular intervals over 48 months.

According to Zandona, a lot is known about caries, but little is known about the process that leads from early caries lesions to cavities. Caries lesions are an early sign that a cavity might develop.

Because some caries lesions progress and become cavities and some don’t, identification of at-risk sites is one of the biggest challenges faced by dentists, according to the researchers’ paper, “The Natural History of Dental Caries Lesions: A Four-Year Observational Study.”
To date, the practice has been to wait and watch lesions until they reach the point where the dentists believe a filling is required, Zandona said.

The purpose of the study was to evaluate whether lesions could be evaluated using the International Caries Detection and Assessment System, a standardized visual examination that requires no special equipment, to identify with greater predictability which ones were more likely to become cavities.

“What we were trying to see was if we could identify when lesions reach the point that they will become cavities,” Zandona said. “Are there some signs we see on teeth that signal when it is progressing towards cavitation? When we see a 1, does it become a 2 and progress to higher scores? What happens when we see a 2? If dentists knew that, they could target prevention at those lesions.”

IU researchers developed the ICDAS examination with a small group of international scientists.
In the study, examiners used the ICDAS to give lesions a score, ranging from 1 to 6 -- with one representing a lesion so small that it was difficult to see and scores greater than 5 indicating what is usually considered a cavity -- and judged whether a lesion was active or not. The lesions were tracked during the 48 months, with some registering higher and higher scores until they progressed to cavities.

After analyzing data collected in the study, the researchers concluded “characterization of lesion severity with ICDAS can be a strong predictor of lesion progression to cavitation.” In other words, the higher the ICDAS score beyond 1, and after a determination that the caries lesion is active, the greater the probability the lesion will develop into a cavity.

“The study shows dentists can identify which teeth are likely to develop cavities,” Zandona said. “They can then institute a preventive measure such as a sealant or a fluoride treatment instead of waiting for lesions to become cavities.

“We don’t want dentists to wait for a lesion to become a cavity,” Zandona said. “In reality, if he sees a lesion that is active and has an ICDAS score higher than 1, chances are it will become a cavity. He should do something preventively before he has to place a filling, because there is a great chance it will become a cavity.”

The study provides information that wasn’t previously available, Zandona said. “Now dentists can have more certainty about what path to take because of what we learned.”
“Through additional funding from NIH, we are now focusing on identifying the metabolic signals on the dental plaque overlaying these lesions that can help us determine if these lesions are active,” Zandona said.